Research progress of modern minimally invasive surgery for hemorrhoids_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XU Zhengrong ,  XIAO Qing

Department of Surgery, Hospital of PLA Unit 63820, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

XIAO Qing, Email: 13981176708@163.com

Keywords：

hemorrhoid; surgical treatment; minimally invasive surgery

DOI：

10.7507/1007-9424.202103137

Video：

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Objective To summarize the modern minimally invasive surgical treatment of hemorrhoids and related clinical research progress.Method Literatures on minimally invasive surgery for hemorrhoids at home and abroad in recent years were collected and reviewed.Results The modern minimally invasive operation of hemorrhoids can be divided into three types. One was for bleeding symptoms to reduce blood supply of hemorrhoids artery for blood vessel block operation; the second one was for prolapse symptoms to restore anal pad anatomical position based on the mucosal resection; the third one was for pain itch symptoms to remove the proliferation of tissue mass based hemorrhoidectomy. All kinds of operations extended to different modified or combined operations. Under the premise of reasonable selection of patients, minimally invasive surgery for hemorrhoids was safe and effective.Conclusions With the rapid development of modern minimally invasive surgery technology and surgical instruments, the surgical treatment of hemorrhoids has been constantly innovated. Any kind of minimally invasive surgery for hemorrhoids has its specific indications and limitations. Therefore, we should pay attention to symptomatic treatment and comprehensive treatment, in order to better play the advantages of minimally invasive surgery for hemorrhoids.

Citation： XU Zhengrong, XIAO Qing. Research progress of modern minimally invasive surgery for hemorrhoids. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(2): 274-280. doi: 10.7507/1007-9424.202103137 Copy

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2.	江维, 张虹玺, 隋楠, 等. 中国城市居民常见肛肠疾病流行病学调查. 中国公共卫生, 2016, 32(10): 1293-1296.
3.	Loder PB, Kamm MA, Nicholls RJ, et al. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg, 1994, 81(7): 946-954.
4.	Morgado PJ, Suárez JA, Gómez LG, et al. Histoclinical basis for a new classification of hemorrhoidal disease. Dis Colon Rectum, 1988, 31(6): 474-480.
5.	Aigner F, Gruber H, Conrad F, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis, 2009, 24(1): 105-113.
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8.	Nisar PJ, Scholefield JH. Managing haemorrhoids. BMJ, 2003, 327(7419): 847-851.
9.	Buntzen S, Christensen P, Khalid A, et al. Diagnosis and treatment of haemorrhoids. Dan Med J, 2013, 60(12): C4754.
10.	罗春生, 贾一平, 杨巍, 等. 超选择动脉栓塞术治疗痔病 3 例初探. 介入放射学杂志, 2016, 25(12): 1089-1093.
11.	Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol, 1995, 90(4): 610-613.
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21.	Zakharchenko A, Kaitoukov Y, Vinnik Y, et al. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique). Diagn Interv Imaging, 2016, 97(11): 1079-1084.
22.	罗春生, 贾一平, 茅爱武, 等. 经血管超选择直肠上动脉栓塞治疗痔病的初步临床分析. 中华医学杂志, 2017, 97(25): 1960-1963.
23.	Han X, Xia F, Chen G, et al. Superior rectal artery embolization for bleeding internal hemorrhoids. Tech Coloproctol, 2021, 25(1): 75-80.
24.	Küçükay MB, Küçükay F. Superior rectal artery embolization with tris-acryl gelatin microspheres: a randomized comparison of particle size. J Vasc Interv Radiol, 2021, 32(6): 819-825.
25.	Tradi F, Mege D, Louis G, et al. Emborrhoid: rectal arteries embolization for hemorrhoid treatment. Presse Med, 2019, 48(4): 454-459.
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1. Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology, 2015, 149(7): 1731-1741.
2. 江维, 张虹玺, 隋楠, 等. 中国城市居民常见肛肠疾病流行病学调查. 中国公共卫生, 2016, 32(10): 1293-1296.
3. Loder PB, Kamm MA, Nicholls RJ, et al. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg, 1994, 81(7): 946-954.
4. Morgado PJ, Suárez JA, Gómez LG, et al. Histoclinical basis for a new classification of hemorrhoidal disease. Dis Colon Rectum, 1988, 31(6): 474-480.
5. Aigner F, Gruber H, Conrad F, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis, 2009, 24(1): 105-113.
6. Chung YC, Hou YC, Pan AC. Endoglin (CD105) expression in the development of haemorrhoids. Eur J Clin Invest, 2004, 34(2): 107-112.
7. 中华医学会外科学分会结直肠肛门外科学组, 中华中医药学会肛肠病专业委员会, 中国中西医结合学会结直肠肛门病专业委员会. 痔临床诊治指南(2006 版). 中华胃肠外科杂志, 2006, 9(5): 461-463.
8. Nisar PJ, Scholefield JH. Managing haemorrhoids. BMJ, 2003, 327(7419): 847-851.
9. Buntzen S, Christensen P, Khalid A, et al. Diagnosis and treatment of haemorrhoids. Dan Med J, 2013, 60(12): C4754.
10. 罗春生, 贾一平, 杨巍, 等. 超选择动脉栓塞术治疗痔病 3 例初探. 介入放射学杂志, 2016, 25(12): 1089-1093.
11. Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol, 1995, 90(4): 610-613.
12. De Nardi P, Capretti G, Corsaro A, et al. A prospective, randomized trial comparing the short- and long-term results of doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade Ⅲ hemorrhoids. Dis Colon Rectum, 2014, 57(3): 348-353.
13. Simillis C, Thoukididou SN, Slesser AA, et al. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg, 2015, 102(13): 1603-1618.
14. Brown SR, Tiernan JP, Watson AJM, et al. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet, 2016, 388(10042): 356-364.
15. Davis BR, Lee-Kong SA, Migaly J, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum, 2018, 61(3): 284-292.
16. 林晖, 朱吉, 归玉琼, 等. 痔动脉结扎肛垫悬吊外剥术与 Milligan-Morgan 术对痔上动脉分支及血流速度影响的临床研究. 中华结直肠疾病电子杂志, 2020, 9(3): 265-269.
17. 林晖, 王琛, 张少军, 等. 痔动脉结扎肛垫悬吊外剥术治疗Ⅲ~Ⅳ度混合痔的多中心随机对照研究. 结直肠肛门外科, 2020, 26(2): 196-201.
18. Pucher PH, Sodergren MH, Lord AC, et al. Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis, 2013, 15(6): e284-e294.
19. Schuurman JP, Go PM, Bleys RL. Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis, 2009, 11(9): 967-971.
20. Vidal V, Louis G, Bartoli JM, et al. Embolization of the hemorrhoidal arteries (the emborrhoid technique): a new concept and challenge for interventional radiology. Diagn Interv Imaging, 2014, 95(3): 307-315.
21. Zakharchenko A, Kaitoukov Y, Vinnik Y, et al. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique). Diagn Interv Imaging, 2016, 97(11): 1079-1084.
22. 罗春生, 贾一平, 茅爱武, 等. 经血管超选择直肠上动脉栓塞治疗痔病的初步临床分析. 中华医学杂志, 2017, 97(25): 1960-1963.
23. Han X, Xia F, Chen G, et al. Superior rectal artery embolization for bleeding internal hemorrhoids. Tech Coloproctol, 2021, 25(1): 75-80.
24. Küçükay MB, Küçükay F. Superior rectal artery embolization with tris-acryl gelatin microspheres: a randomized comparison of particle size. J Vasc Interv Radiol, 2021, 32(6): 819-825.
25. Tradi F, Mege D, Louis G, et al. Emborrhoid: rectal arteries embolization for hemorrhoid treatment. Presse Med, 2019, 48(4): 454-459.
26. 周庆健, 卢润广. M-M 与 RPH 治疗环状混合痔的临床疗效及并发症比较. 结直肠肛门外科, 2018, 24(1): 45-49.
27. Shanmugam V, Thaha MA, Rabindranath KS, et al. Systematic review of randomized trials comparing rubber band ligation with excisional haemorrhoidectomy. Br J Surg, 2005, 92(12): 1481-1487.
28. Peng BC, Jayne DG, Ho YH. Randomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles. Dis Colon Rectum, 2003, 46(3): 291-297.
29. Iyer VS, Shrier I, Gordon PH. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum, 2004, 47(8): 1364-1370.
30. Thomson WH. The nature of haemorrhoids. Br J Surg, 1975, 62(7): 542-552.
31. Thomson WH. The nature and cause of haemorrhoids. Proc R Soc Med, 1975, 68(9): 574-575.
32. Yeo D, Tan KY. Hemorrhoidectomy—making sense of the surgical options. World J Gastroenterol, 2014, 20(45): 16976-16983.
33. Longo A. Treatment of haemorrhoids disease by reduction of mucosa and haemorrhoidal prolapse with a circular-suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery. Rome, 1998: 777-784.
34. 贺平, 陈宏亮. 吻合器痔上粘膜环切钉合术与 Milligan-Morgan 术随机对照试验的系统评价与 meta-分析. 第十八届中国中西医结合学会大肠肛门病专业委员会学术会议暨甘肃省第五届结直肠肛门外科学术年会. 兰州: 2015.
35. 张慧嫦, 熊秋华, 罗秀琼. PPH 联合部分肛门内括约肌切断术应用于重度混合痔并直肠肛管静息压高压患者的疗效观察. 中国普外基础与临床杂志, 2020, 27(4): 454-459.
36. Porrett LJ, Porrett JK, Ho YH. Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg, 2015, 100(1): 44-57.
37. Lai HJ, Jao SW, Su CC, et al. Stapled hemorrhoidectomy versus conventional excision hemorrhoidectomy for acute hemorrhoidal crisis. J Gastrointest Surg, 2007, 11(12): 1654-1661.
38. Lin HC, Lian L, Xie SK, et al. The tissue-selecting technique: segmental stapled hemorrhoidopexy. Dis Colon Rectum, 2013, 56(11): 1320-1324.
39. 范雷涛, 孙源, 李春雨. 比较两种联合术式治疗混合痔的临床疗效和肛肠动力学变化. 中国普外基础与临床杂志, 2021, 28(1): 79-84.
40. Leung ALH, Cheung TPP, Tung K, et al. A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique. Tech Coloproctol, 2017, 21(9): 737-743.
41. Lin HC, Luo HX, Zbar AP, et al. The tissue selecting technique (TST) versus the Milligan-Morgan hemorrhoidectomy for prolapsing hemorrhoids: a retrospective case-control study. Tech Coloproctol, 2014, 18(8): 739-744.
42. Lin HC, He QL, Shao WJ, et al. Partial stapled hemorrhoidopexy versus circumferential stapled hemorrhoidopexy for grade Ⅲ to Ⅳ prolapsing hemorrhoids: a randomized, noninferiority trial. Dis Colon Rectum, 2019, 62(2): 223-233.
43. Zhang G, Liang R, Wang J, et al. Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade Ⅲ and Ⅳ internal hemorrhoids (Meta-analysis). Int J Surg, 2020, 74: 53-60.
44. Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal rectal resection (STARR). Annual Cleveland Clinic Florida Colorectal Disease Symposium, 2004.
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46. Renzi A, Brillantino A, Di Sarno G, et al. PPH-01 versus PPH-03 to perform STARR for the treatment of hemorrhoids associated with large internal rectal prolapse: a prospective multicenter randomized trial. Surg Innov, 2011, 18(3): 241-247.
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